Importance of Increasing ICH CAHPS Survey Response Rates
folder_openOther Announcementscalendar_todayPosted October 7, 2021

As we approach the start of data collection for the 2021 Fall Survey, CMS and the ICH CAHPS Coordination Team would like to take this time to address the continuing decline in the ICH CAHPS Survey response rates. We ask that you take the time to read this lengthy announcement.

We know that many ICH patients are asked to participate in the survey up to two times a year, and that many people are feeling fatigue in general because of the ongoing pandemic. The ICH CAHPS Survey is critical for both helping Medicare to improve the overall quality of dialysis care in the U.S., and for ensuring that ICH patients and their family members can make informed decisions regarding the in-center dialysis care they need. Patient participation is critical to this effort.

We want to take this opportunity to share some updates on what CMS and the Coordination Team are doing, as well as a reminder of patient engagement ideas that we hope will help to increase response rates in our upcoming survey periods.

Updates from the ICH CAHPS Coordination Team

  • New Patient Page on the ICH CAHPS Website: In July 2021, several enhancements were made to the ICH CAHPS website, including the addition of a dialysis patient page with FAQs about participating in the survey ( Survey vendors and participating facilities are encouraged to:
    • direct ICH patients to this webpage should they have any questions about the survey; and
    • include a reference to this webpage on any ICH CAHPS Survey flyers/posters used by the facility to promote the survey (reminder to send any edited flyer/posters to the Coordination Team for approval).
  • Survey Revision Efforts: Over the years, CMS has received feedback that the length of the survey may have a negative impact on response rates. As a result of this feedback, the Coordination Team conducted a Technical Expert Panel (June 2020) and ICH patient focus groups (March 2021) to help guide potential revisions to shorten the current ICH CAHPS Survey, that we hope will have the added effect of reducing respondent burden.
  • Web Mode Experiment: The Coordination Team will also be conducting a web mode experiment in the near future to determine whether adding a web mode to the ICH CAHPS Survey protocol has the potential to improve overall response rates.

Reminders of Ideas for ICH Patient Engagement

  • ICH CAHPS Flyer or Poster: Consider using a poster/flyer or other awareness materials within your facilities, providing a heads-up to patients that their participation in the ICH CAHPS Survey is important.
    • The Coordination Team developed a CMS-approved ICH CAHPS poster/flyer that contains information about the survey; the template (without official CMS logo) can be found on the ICH CAHPS website: Approval for using this exact template is not necessary; however, please contact the Coordination Team at to obtain the template version that includes the official CMS logo.
    • ICH facilities are also permitted to create their own poster/flyer or other awareness materials, with approval from the Coordination Team. Materials can be submitted for review to Please keep in mind that the survey name included on the mail surveys that patients receive is "Medicare In-Center Hemodialysis Survey." If creating your own, facilities are encouraged to include a reference to the new dialysis patient page located on the ICH CAHPS website homepage: (
  • Show Patients the ICH CAHPS Survey Envelope: Show patients the ICH CAHPS Survey envelope so they can easily recognize it should they receive one in the mail. The new envelope template (implemented with the 2021 Spring Survey) can be found in Chapter 5 and 7 in the ICH CAHPS Administration and Specifications Manual: The Coordination Team can also email the envelope template to ICH facilities upon request.
  • Remind Patients of the Survey Fundamentals: Explain the details of the ICH CAHPS Survey with your patients, including:
    • Communicate to patients the purpose of the survey, why their responses matter, and how they can access the survey results on the Care Compare website at
    • Explain to patients that the survey is conducted every spring (April-July) and fall (October-January) and that they may be asked to participate up to two times a year. Make sure that they know that they may be contacted via mail or phone (or both) by an independent vendor.
    • Let patients know that they may receive the ICH CAHPS Survey and that honest feedback is appreciated. Make sure they know that no one from the facility will know who receives the survey, who responds to the survey, or how they answered any of the questions.
    • Discuss publicly reported survey results and facility scores with patients and the facility's plans, if any, to improve patient care based on survey results.

Things to Keep in Mind when Implementing Patient Engagement

Although patient engagement is critically important, ICH facilities should make sure to keep the following in mind when implementing any patient engagement techniques:

  • Patients receiving ICH treatment are an especially vulnerable population, relying on an ICH facility and its staff for life-sustaining care. Some patients might be reluctant to participate in the ICH CAHPS Survey or provide feedback on the dialysis care they receive for fear of retribution by facility staff. Participation is always voluntary.
  • Patients may be reluctant to provide survey responses that accurately reflect their experience with the care provided by their ICH facility because they might perceive that government agencies are not responsive to patients' concerns. Facilities should not imply or persuade patients to respond to items in a particular way.
  • If patients ask ICH facility personnel to help them complete the survey, facility staff should instruct them to ask a family member or friend for help. Staff at a dialysis facility are not allowed to help patients complete the survey.
  • If sample patients have any questions about the survey, facility staff should instruct them to call their ICH CAHPS Survey vendor's toll-free telephone number, which is included in the prenotification and mail survey cover letters. Staff at a dialysis facility should not attempt to answer survey-specific questions asked by the patient.

As we work towards our end goal of improving the ICH CAHPS Survey, any changes that are made to the survey or new data collection modes will be shared with survey vendors and ICH facilities. At this point, we do not have a solid timeframe for any potential changes, as a final decision depends on a number of factors; making such changes to an established survey is a lengthy process. In the meantime, we hope that the information provided here will help ICH facilities employ useful patient engagement tactics to help increase ICH CAHPS Survey response rates! And as always, if you have additional ideas or proven tactics for increasing response rates, please share with the Coordination Team at